Depression is a natural accompaniment to chronic illness. It could hardly be otherwise. As the illness eats away at the body, it Inevitably exacts an ever greater toll on the spirit.

There is simply no escaping the illness, every minute of every day. Each action requires an effort of the soul comparable to the physical effort required to make the body respond. Lurking in the background is a question that gnaws at the soul: "Will I be able to do everything I ask of my body today?" Further, "How much longer will I be able to carry on as I do now?" Every change in our condition demands a new effort to respond, to recoil. When our emotional resources are exhausted, when we feel beaten to a frazzle, our bodily chemicals become unbalanced. We are depressed.

Depression manifests itself in a myriad of ways. Most notably, there can be changes in any or all of life's basic patterns. Appetite will frequently be diminish. Alternatively, some individuals will eat compulsively. Emotions are not controlled. From snapping hostilely at everyone around to weeping at the drop of a hat, our emotions are on the surface. Ambition diminishes if not disappears, as does self-confidence. Making a decision becomes difficult if not impossible. Meeting life's responsibilities, whether at home or work is done poorly if at all. Falling asleep (or back to sleep after awakening during the night) takes longer and longer, if it ever happens. Conversely, some depressed individuals use sleep as an escape. I know of one woman who would pack her children off to school in the morning, then go back to bed. Good news brings almost no relief, while a heightened sense of guilt and shame hangs over life. There is, in short, a constant feeling of helplessness and hopelessness.

For fourteen years I watched my level of disability increase. The increase was not a steady progression, but a series of plateaux, each at a higher level of disability than the last. Thus for the first several years following presentation of the illness, life continued largely unchanged. Nearly three years into it, for example, I walked more than a mile with my year old daughter in a back carrier. Other activities were fundamentally unaffected by the illness: swimming, cooking, gardening, handwriting, driving, dressing, eating, and essentially all other ordinary activities.

As the fifth year of my illness approached I waited anxiously. For my neurologist allowed that that is a benchmark year: The research indicates that if an MS sufferer is walking after five years, they are not likely ever to have to rely on a wheelchair. Well, I was walking after five years, albeit with the aid of Canadian crutches. Silently, I cheered inside. I thought I was home free. But it did not last. All the determination and fight notwithstanding, I reluctantly yielded to the necessity of a wheelchair. Around the same time I realized my legs were not strong enough to drive responsibly. Lifting my right foot from the accelerator with my right hand, and placing it on the brake pedal, I concluded, was not a safe way to drive. I relinquished the wheel to my wife.

No longer able to walk much, I was still able to stand for long periods of time. At least I could still do most of the cooking at home. Not only is cooking along my favorite avocations, but I could yet feel that I was making a significant contribution to the household. Dressing became more challenging, but a loving wife helped me regularly. Teaching continued apace, but now pushing the wheelchair became more difficult. As well, getting to a standing position was a greater challenge, but many helpful students were always willing to lend a hand. My community volunteer activities continued unabated, although I always attended meetings in my wheelchair. Swimming was still possible for me (I revel in the memory of swimming laps beside my older daughter), but climbing up and down the pool ladder became considerably more dicey. I was yet sufficiently self-assured of my abilities that I accepted the responsibility of president of my synagogue.

Summers have been particularly difficult for me, with the MS making me especially weak from the heat and humidity. Never was this more true than during the summer of 1994. During July, the twenty-five year old air conditioner in our house gave up the ghost. Although a local company installed a new unit in just a couple of days, it was not before the temperature in the house reached a steamy 86 degrees. Weak does not begin to describe how debilitated I was. A month later I slipped while pouring a kettle of boiling water, and my hand hit a red hot burner. With third degree burns on my left hand, my cooking career was over. Upon removing the dressing the first time after the accident, I came within a hairbreadth of passing out at the sight of my fingers. The burns shook my confidence as much as they disabled my hand.

Meanwhile, academic year 1994-95 was the first time I taught regularly from the wheelchair. While the students were unaffected by my being seated, it wore on me. "What has become of me," I wondered, "that I can't even stand in front of a class?" Would that I paid more attention to the students and less to myself!

By the middle of 1995, I realized that I was grossly overextended. Approaching the end of my third year as president of the synagogue my duties included responsibility for the budget. As the end of the fiscal year approached, a deficit loomed. While there were other officials in the synagogue, none felt a responsibility for the budget like I did. Additionally, whenever anything needed doing or something went wrong, I was always called.

Beyond presiding over the synagogue, I was nearing the conclusion of my seventh and eighth years respectively on the boards of directors of the Syracuse Hebrew Day School and the Syracuse Jewish Community Center. Both mentally and emotionally drained, I frequently skipped meetings. These absences only contributed to my feelings of inadequacy.

Beyond the burden of these three communal duties, my house had become a greater strain on me as well. For eight years I had negotiated a flight of stairs to enter and exit the house, as well as to get to my desk. As the years passed, they became a progressively greater challenge. To solve the problem, we had a stair lift installed. After using it successfully for two years, a decline in my condition made getting on and off it a chore and a peril. I would stand at the top of the stairs and wonder, "Is this the time when I go crashing to the bottom?" It got to the point where I required assistance whenever I used the stair lift.

In sum I was exhausted in every imaginable way. As a result, I found myself frequently waking up in the middle of the night. Additionally, I was having difficulty falling back to sleep. The problems of the day would immediately consume me. Try as I might, I was unable either to solve them or clear them from my thoughts. Hours would pass, eventually exhaustion would overcome me, and I would fall back to sleep. In the morning I would awake and spend the day tired. The more fatigued I became, the less I was able to do. Worse, not only my ability, but my ambition and confidence were spent as well.

When the cycle continued, my wife encouraged me to tell my neurologist. After hearing my tale of laying awake four hours, he prescribed an antidepressant. Despite feeling perfectly awful, I was still not ready to admit that I was depressed. Rather, I still labored under the foolish misconception that depression is a function of a weak character. The only remedy someone who is depressed needs, I mistakenly thought, is to clench their jaw, grasp the nettle firmly, and buck up.

How naïve, judgmental, and absolutely wrong I was. The medication I took for the depression had a half-life in excess of two weeks. Accordingly, it had little to no effect on me for almost a month. Meanwhile, I found that my bladder would only hold 3 to 4 ounces of urine before demanding to be emptied. This annoyed and distressed me because I was accustomed to catheterizing 6 to 10 ounces from my bladder. Worse, my otherwise equable wife was growing short with me. Just when I was about to report my frustration to my neurologist, my wife came home from the office and announced, "I was reading the PDR [Physician's Desk Reference] today, and discovered that 4% of all patients who take Prozac develop urinary urgency." No sooner did I learn that when I asked my neurologist for a different antidepressant. Before changing antidepressants, however, I first had to evacuate my body of a remaining Prozac. This was necessary because each drug has its own side effects. In order not to confuse different drugs' side effects, it is essential not to overlap them.

I stopped taking Prozac before it had a chance to be fully effective. Consequently, life was still perfectly awful for me. I had no ambition to do anything, nor was I satisfied with anything I even attempted. Then I received a phone call from a psychologist/friend who was unaware of my depression. To my utter amazement, he talked to me as another professional. For 30 minutes he treated me better than I had been treating myself. The conversation left me "walking on air." As a result, I determined that I did not want to be depressed. So there! Take that, hhrrumpff!

Little did I know that my bravado was the result of the Prozac actually being efficacious. It just happened to coincide with the psychologist's call. The antidepressant made it possible to cope with life's wrinkles, to face life's difficulties. No longer did every mole hill take on the proportions of a mountain. My motivation to do things returned. The weight of the world was lifted from my shoulders. I stopped chewing off my family's heads in response to every comment or question. Hard as it was to believe, I was not an altogether worthless human being (!).

Interestingly, the Prozac didn't make everything better. Contrary to popular characterizations I've heard, they are not "happy pills." Anti-depressants aren't intended to have that effect. They alone will not chase away the blues. Rather, they are only supposed to make it possible for us to make our lives better.

A few days later, the Prozac fell below the therapeutic level. My determination promptly crumbled, my confidence dissolved, and a black cloud descended over me. My depression returned with a vengeance. Luckily, depression was already familiar to me, so I was able to recognize it. I still felt horrendous, but I also knew that an antidepressant would relieve my condition. Until I could get the level of antidepressant in my blood I was able to cope with the depression.

The larger, more important lesson I derived from my experience is that depression is genuine. It cannot be defeated either by determination or will. Rather, it is a function of a chemical imbalance in the brain that can be treated successfully with medication. I absolutely didn't believe it until it happened to me.

While I never contemplated suicide, after suffering the pangs of depression, I can better understand how people consider it. Nothing seemed so hopeless, and never did I feel so helpless and useless as during the depths of depression. I had always fashioned myself a strong individual, capable of meeting all of life's challenges. When life got to be too much for me, though, I was relieved to have found that others less arrogant and wiser than me figured out ways to treat it.

Arguably, among the greatest tragedies of our day the individual whose depression goes untreated. Repeatedly, accounts fill the media of supposedly terminally ill individuals who, upon autopsy, are found only to be suffering from depression. In the depths of depression, they opted for suicide. To me their death veritably defines tragedy.